title: Longitudinal course and predictors of suicidal ideation in a rural community sample.
abstract: OBJECTIVE
  Suicide rates in rural Australia are higher than in urban areas. No existing research has explored the long-term patterns and predictors of change in suicidal ideation within rural areas. This report uses longitudinal data and multiple time points to determine predictors of the trajectory of suicidal ideation in rural Australia.
  
  
  METHODS
  Participants in the Australian Rural Mental Health Study (ARMHS) completed self-report surveys at baseline, 12 and 36 months, reporting their psychological and social well-being, and suicidal ideation. Generalised linear mixed models explored these factors as correlates and predictors of suicidal ideation across 3 years using multiple data points.
  
  
  RESULTS
  A total of 2135 participants completed at least one wave of ARMHS, and hence were included in the current analysis. Overall, 8.1% reported suicidal ideation during at least one study wave, 76% of whom reported suicidal ideation intermittently rather than consistently across waves. Across the three time points, suicidal ideation was significantly associated with higher psychological distress (OR 1.30, 95% CI 1.23 to 1.37), neuroticism (OR 1.15, 95% CI 1.04 to 1.27), and availability of support (OR 0.80, 95% CI 0.69 to 0.92), with a non-significant association with unemployment (OR 1.73, 95% CI 0.93 to 3.24) even after controlling for the effects of perceived financial hardship. Future suicidal ideation was significantly predicted by distress (OR 1.16, 95% CI 1.09 to 1.23) and neuroticism (OR 1.17, 95% CI 1.03 to 1.32), with a non-significant association with unemployment (OR 2.11, 95% CI 0.41 to 2.27). Predictive effects for marital status, social networks, sense of community and availability of support did not remain significant in the full multivariate analysis.
  
  
  CONCLUSIONS
  Fluctuations in suicidal ideation are common, and may be associated with changes in psychological and social well-being. Public health strategies, focusing on encouraging help-seeking among those with higher psychological distress, lower social support, and unstable or absent employment opportunities, may be a useful long-term initiative to reduce the prevalence of suicidal ideation in the general rural community.
authors.affiliation: 1Centre for Translational Neuroscience and Mental Health, University of Newcastle, Callaghan, Australia.
authors.forename: Tonelle E
authors.initials: TE
authors.lastname: Handley
authors.forename: John R
authors.initials: JR
authors.lastname: Attia
authors.forename: Kerry J
authors.initials: KJ
authors.lastname: Inder
authors.forename: Frances J
authors.initials: FJ
authors.lastname: Kay-Lambkin
authors.forename: Daniel
authors.initials: D
authors.lastname: Barker
authors.forename: Terry J
authors.initials: TJ
authors.lastname: Lewin
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Kelly
mesh_terms: D000223:Adaptation, Psychological; D001315:Australia; D005260:Female; D006306:Health Surveys; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012424:Rural Population; D059020:Suicidal Ideation
keywords: Suicidal ideation; employment; longitudinal; psychological distress